Provider Demographics
NPI:1548994536
Name:BOATENG-GYABAH, EMMANUEL KWEKU
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:KWEKU
Last Name:BOATENG-GYABAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7918 DUNHILL VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3629
Mailing Address - Country:US
Mailing Address - Phone:443-546-8769
Mailing Address - Fax:
Practice Address - Street 1:10440 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3561
Practice Address - Country:US
Practice Address - Phone:617-297-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician